Lifestyle changes may improve your bladder control problem or enhance your response to medical treatments. Find out about these strategies for improving bladder control problems.

By Mayo Clinic Staff

You've been struggling with the embarrassment and discomfort of a bladder control problem for some time now. Maybe you hoped it would go away on its own, but things aren't getting any better. In fact, your bladder control problem seems to be getting worse.

You're ready to make some changes, but what exactly can you do? There are some simple strategies you can try on your own that may help improve your bladder control problem.

Doctors often call these strategies "lifestyle modifications" or "behavior therapies." They're safe, easy, effective and inexpensive. These techniques can be used before trying other types of treatment, such as medications or surgery, or in combination with them.

How much fluid you drink and the types of food you eat may influence your bladder habits.

Too much fluid

Drinking too much fluid of any kind makes you urinate more often. If you drink too much over a short time, this can overwhelm your bladder and create a strong sense of urgency. If you exercise a lot or work outdoors regularly, you may need to drink more fluids.

Rather than drink a large amount all at once, try drinking smaller amounts throughout the day. For example, drink about two 8-ounce glasses (237 milliliters) at each meal and one 8-ounce glass between meals. That way, you'll end up at the recommended amount of roughly 8 cups (about 1.9 liters) of fluid daily.

If you have to get up several times at night to urinate, try drinking more of your fluids in the morning and afternoon, and eliminate alcohol and caffeinated beverages. Although water is best for your bladder, remember that fluids come from any beverage you drink and from foods such as soup.

Too little fluid

Drinking too little fluid can lead to increased amounts of body waste products in your urine. Highly concentrated urine is dark yellow and has a strong smell. It can irritate your bladder, increasing the urge and frequency with which you need to go.

Bladder irritants

Some foods and beverages can irritate your bladder. Caffeine and alcohol both increase urine production. This can lead to increased frequency and urgency of urination. Caffeine can also cause bladder spasms.

Certain acidic fruits — oranges, grapefruits, lemons and limes — and fruit juices, spicy foods, tomato-based products, carbonated drinks, artificial sweeteners, corn syrup, sugar, chocolate, coffee, and tea may irritate your bladder or make you leak urine. Why these items sometimes cause irritation isn't understood, and what causes bladder irritation may vary from person to person.

If caffeine or alcohol are regular parts of your diet, try eliminating them for about a week to see if your symptoms improve. Consider also avoiding foods that might be bladder irritants for about a week or so. Then gradually — every one to two days — add one food back into your diet, noting any changes in urinary urgency, frequency or incontinence.

You might not have to eliminate your favorite foods entirely. Simply cutting down on the amount might help, too.

When you have an overactive bladder, you can get used to urinating frequently or at the slightest urge. Sometimes, you may go to the toilet even when you don't have the urge because you want to avoid an accident. After a while, your bladder begins sending "full" messages to your brain even when it's not full, and you feel compelled to urinate.

Bladder training, or retraining, involves adjusting your habits. You go to the toilet on a set schedule — even if you have no urge to urinate — gradually increasing the time between urination. This allows your bladder to fill more fully and gives you more control over the urge to urinate.

A bladder-training program usually follows these basic steps:

  • Identify your pattern. For a few days, keep a diary in which you note every time you urinate. Your doctor can use this diary to help you establish a schedule for your bladder training.
  • Extend your urination intervals. Using your bladder diary, pinpoint the amount of time from one urination to the next. Then extend that by 15 minutes. So, if your usual interval is one hour, you work to extend that to an hour and 15 minutes.
  • Stick to your schedule. Once you've established a schedule, do your best to stick to it. Start by urinating immediately after you wake up in the morning. Thereafter, if an urge arises, but it's not time for you to go, try as hard as you can to wait it out. If you feel you're going to have an accident, go to the toilet but then return to your schedule.
  • Practice relaxing. If you feel a sudden need to urinate before your scheduled time, try to stand still or sit down. Then take deep breaths, while contracting your pelvic muscles and imagining the urge going away. Once you feel relaxed, slowly make your way to the bathroom if you still need to. With time, this practice can help reduce feelings of urgency.
  • Increase your intervals. Gradually lengthen the time between trips to the toilet until you reach intervals of two to four hours. You might do this by extending your intervals an additional 15 minutes each week until you reach the desired goal. Be sure to increase your time limit slowly so that you give yourself the best chance for success.

Don't be discouraged if you don't succeed the first few times. Keep practicing, and your ability to maintain control is very likely to increase.

Your pelvic floor muscles and urinary sphincter help control urination. You can strengthen these muscles by regularly doing pelvic floor exercises, commonly referred to as Kegels.

The pelvic floor muscles work to open and close the urethra — the tube that carries urine from the bladder to the exterior of your body. These muscles also support the bladder as you exert yourself doing everyday activities such as walking, standing, lifting and sneezing.

  • Practice Kegel exercises. To perform Kegels, squeeze your pelvic floor muscles as if you're trying to stop your stream of urine. Your doctor may recommend that you do a set of these exercises three or four times a day to treat your bladder control problem.

    Kegels are especially effective for women with stress incontinence, but they can also help reduce or eliminate urge incontinence.

    You may want to ask your doctor for help or to refer you to a specialist who can teach you the proper way to do these exercises, because many people unknowingly do them incorrectly.

  • Biofeedback. Biofeedback is a therapy used to help train pelvic floor muscles. Sensors placed near the muscles transmit exertion levels to a computer, which displays the levels on the screen. This immediate feedback helps some people master Kegel exercises faster because they can see whether they're using the correct muscles. Biofeedback can be done with a health care provider or with a home device.
  • Vaginal weights. Cone-shaped weights are another option used to help with Kegel exercises. You place a weight in your vagina and contract your pelvic floor muscles to keep it from falling out. Many cones come in sets of varying weight levels, so you can build up to heavier weights as your pelvic floor muscles become stronger.

Certain medications, excess weight, smoking and physical inactivity may indirectly contribute to bladder control problems. If you address these factors, bladder-specific techniques — such as avoiding bladder irritants and bladder training — may be even more likely to work.

  • Manage your medications. Examples of drugs that may contribute to bladder control problems include high blood pressure drugs, heart medications, diuretics, muscle relaxants, antihistamines, sedatives and antidepressants. If you develop incontinence or difficulty urinating while taking these drugs, talk to your doctor. You may be able to avoid urinary side effects by taking another medicine.
  • Maintain a healthy weight. Being overweight may contribute to bladder control problems, particularly stress incontinence. Excessive body weight puts pressure on your abdomen and bladder, sometimes resulting in leakage. If you're overweight and experiencing a bladder control problem, losing weight may help.
  • Stop smoking. Smokers are more likely to have bladder control problems and are more likely to experience more-severe symptoms. Heavy smokers also tend to develop a chronic cough, which can place added pressure on the bladder and aggravate urinary incontinence. Improving urinary incontinence may be one of many benefits of stopping smoking.
  • Be active. Some studies indicate that regular physical activity reduces bladder control problems. Try for at least 30 minutes of low-impact moderate activity — such as walking briskly, biking or swimming — most days of the week.
  • Minimize constipation. Straining too much during bowel movements can damage the pelvic floor. Unfortunately, some medications used to treat bladder control problems can make constipation worse. Exercising, drinking enough water and eating high-fiber foods, such as lentils, beans, and fresh vegetables and fruit, may help improve constipation.
  • Manage chronic cough. If you have a cough that doesn't go away, it could be making your bladder control problem worse. See your doctor about possible treatment options.

Behavior therapies can improve bladder control with minimal side effects. These techniques take time and practice before you see results. But persistence pays off. If you stick with the program, you'll likely see an improvement in your symptoms. And if one of these approaches doesn't work, talk with your doctor about exploring other treatment options that may help.

July 19, 2014